Demographics, Substance Use Behaviors, and Clinical Characteristics of Adolescents With e-Cigarette, or Vaping, Product Use-Associated Lung Injury (EVALI) in the United States in 2019
Demographics, Substance Use Behaviors, and Clinical Characteristics of Adolescents With e-Cigarette, or Vaping, Product Use-Associated Lung Injury (EVALI) in the United States in 2019
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DOI：
10.1001/jamapediatrics.2020.0756
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发表时间：
2020-07-01
期刊：
影响因子：
26.1
通讯作者：
Wiltz, Jennifer L.
中科院分区：
文献类型：
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作者：
Adkins, Susan H.;Anderson, Kayla N.;Wiltz, Jennifer L.
问题：患有电子烟或电子烟产品使用相关肺损伤（EVALI）的青少年与患有EVALI的成年人是否不同？结果-共有2155例患者被纳入本横断面研究。根据国家监测数据，患有EVALI的青少年比患有EVALI的成年人更有可能报告使用含有四氢大麻酚的非正规来源的电子烟或电子烟产品，并出现注意力缺陷/多动障碍、哮喘以及胃肠道和全身症状。公共卫生和临床工作可能包括向青少年传达有关含四氢大麻酚的电子烟或vaping产品的风险，特别是那些从非正式渠道获得的产品，以及它们与EVALI的关联。这项横断面研究通过描述人口统计学特征，物质使用行为和电子烟或vaping的临床特征的差异，与成人相比，青少年产品使用相关性肺损伤（EVALI）。重要性迄今为止，有关青少年电子烟或电子烟产品使用相关性肺损伤（EVALI）特征的信息有限。目的通过描述青少年与成人在人口统计学、物质使用行为和EVALI临床特征方面的差异，为公共卫生和临床实践提供信息。使用2019年EVALI爆发期间向疾病控制和预防中心报告的监测数据来计算校正的患病率（aPR）及其95% CI，并测试360名住院或死亡青少年与859名年轻人和936名EVALI成人（N = 2155）之间的差异。主要结果和测量人口统计学、物质使用行为和临床特征。本横断面研究包括360名住院或死亡的青少年（年龄范围，13-17岁; 67.9%男性）与859名年轻成人（年龄范围，18-24岁; 72.4%男性）和936名成人（年龄范围，25-49岁; 65.6%男性）。被诊断患有EVALI的青少年报告使用任何含尼古丁（62.4%），任何含四氢大麻酚（THC）（81.7%）以及两种（50.8%）类型的电子烟或电子烟产品。青少年更常报告获得含尼古丁和含四氢大麻酚的电子烟或电子烟产品的非正式来源（尼古丁为50.5%，THC为96.5%）（尼古丁为19.8%[aPR，2.49; 95% CI，1.78-3.46]，THC为86.9%[aPR，1.11; 95% CI，1.05-1.18]）或成人（尼古丁为24.3%[aPR，2.06; 95% CI，1.49-2.84]，THC为75.1%[aPR，1.29; 95% CI，1.19-1.40]）。精神、情绪或行为障碍是常见的;青少年（18.1%）中注意力缺陷/多动障碍病史的可能性几乎是成人（4.9%）的4倍（aPR，3.74; 95% CI，1.92-7.26）。青少年（43.6%）比成人（28.3%）更可能报告哮喘史（aPR，1.53; 95% CI，1.14-2.05）。青少年中胃肠道和全身症状（分别为90.9%和97.3%）比成人（分别为75.3%和94.5%）更常见（aPR，1.20; 95% CI，1.13-1.28和aPR，1.03; 95% CI，1.00-1.06）。由于数据缺失，可能无法根据提供的数据计算百分比。公共卫生和临床专业人员应继续向青少年提供有关EVALI与含THC的电子烟或电子烟产品使用之间关系的信息，特别是通过非正式渠道获得的产品，以及使用任何电子烟或电子烟产品都是不安全的。与成人相比，EVALI青少年似乎更经常有哮喘和精神，情绪或行为障碍的病史，如注意力缺陷/多动症，并报告非特异性问题，包括胃肠道和全身症状;因此，建议获得保密的物质使用史，包括电子烟或vaping产品的使用。
Question Do adolescents with e-cigarette, or vaping, product use-associated lung injury (EVALI) differ from adults with EVALI? Findings A total of 2155 patients were included in this cross-sectional study. Based on national surveillance data, adolescents with EVALI are more likely than adults with EVALI to report the use of informally sourced e-cigarette or vaping products that contain tetrahydrocannabinol and to have attention-deficit/hyperactivity disorder, asthma, and gastrointestinal and constitutional symptoms. Meaning Public health and clinical efforts could include messaging to adolescents about the risks of tetrahydrocannabinol-containing e-cigarette or vaping products, especially those obtained from informal sources, and their association with EVALI.This cross-sectional study informs public health and clinical practice by describing differences in demographic characteristics, substance use behaviors, and clinical characteristics of e-cigarette, or vaping, product use-associated lung injury (EVALI) among adolescents compared with adults.Importance To date, limited information is available on the characteristics of adolescents with e-cigarette, or vaping, product use-associated lung injury (EVALI). Objective To inform public health and clinical practice by describing differences in demographics, substance use behaviors, and clinical characteristics of EVALI among adolescents compared with adults. Design, Setting, and Participants Surveillance data reported to the Centers for Disease Control and Prevention during the 2019 EVALI outbreak were used to calculate adjusted prevalence ratios (aPRs) with 95% CIs and to test differences between 360 hospitalized or deceased adolescents vs 859 young adults and 936 adults with EVALI (N = 2155). Main Outcomes and Measures Demographics, substance use behaviors, and clinical characteristics. Results Included in this cross-sectional study were 360 hospitalized or deceased adolescents (age range, 13-17 years; 67.9% male) vs 859 young adults (age range, 18-24 years; 72.4% male) and 936 adults (age range, 25-49 years; 65.6% male) with EVALI. Adolescents diagnosed as having EVALI reported using any nicotine-containing (62.4%), any tetrahydrocannabinol (THC)-containing (81.7%), and both (50.8%) types of e-cigarette or vaping products. Informal sources for obtaining nicotine-containing and THC-containing e-cigarette or vaping products were more commonly reported by adolescents (50.5% for nicotine and 96.5% for THC) than young adults (19.8% for nicotine [aPR, 2.49; 95% CI, 1.78-3.46] and 86.9% for THC [aPR, 1.11; 95% CI, 1.05-1.18]) or adults (24.3% for nicotine [aPR, 2.06; 95% CI, 1.49-2.84] and 75.1% for THC [aPR, 1.29; 95% CI, 1.19-1.40]). Mental, emotional, or behavioral disorders were commonly reported; a history of attention-deficit/hyperactivity disorder was almost 4 times more likely among adolescents (18.1%) than adults (4.9%) (aPR, 3.74; 95% CI, 1.92-7.26). A history of asthma was more likely to be reported among adolescents (43.6%) than adults (28.3%) (aPR, 1.53; 95% CI, 1.14-2.05). Gastrointestinal and constitutional symptoms were more common in adolescents (90.9% and 97.3%, respectively) than adults (75.3% and 94.5%, respectively) (aPR, 1.20; 95% CI, 1.13-1.28 and aPR, 1.03; 95% CI, 1.00-1.06, respectively). Because of missing data, percentages may not be able to be calculated from data provided. Conclusions and Relevance Public health and clinical professionals should continue to provide information to adolescents about the association between EVALI and THC-containing e-cigarette or vaping product use, especially those products obtained through informal sources, and that the use of any e-cigarette or vaping product is unsafe. Compared with adults, it appears that adolescents with EVALI more frequently have a history of asthma and mental, emotional, or behavioral disorders, such as attention-deficit/hyperactivity disorder, and report nonspecific problems, including gastrointestinal and constitutional symptoms; therefore, obtaining a confidential substance use history that includes e-cigarette or vaping product use is recommended.